PACE Medical Director

PACE (Program of All-Inclusive Care for the Elderly) is a nonprofit recognized as the gold standard of care coordination for individuals living with chronic conditions and diminished functionality. Local PACE partners with Alivia Care / Alivia Care Solutions. It is the first of its kind in North Florida, and care is delivered at The PACE Place Center and at the participants home.

Position Summary :

The Medical Director provides general medical direction and supervision of the medical aspects of care for PACE Organization. The Medical Director is responsible for the delivery and oversight of participant care, clinical outcomes, implementation and oversight of the quality assessment and performance improvement program, utilization management, development and maintenance of medical policies and procedures / standards and protocols. The Medical Director will provide direction and supervision to primary care physicians, nurse practitioners, nursing staff and allied health services and leadership of the program among staff, colleagues, and providers in the community.

Duties and Responsibilities :

• Oversight and responsibility for the PACE Quality Program
• Understand the regulations related to Quality Assessment and Performance Improvement (QAPI) and PACE and the medical director’s role.
• The medical director is responsible for the delivery of participant care and clinical outcomes.
• Proactively develop a collaborative working relationship with the quality manager.
• Assume overall accountability and responsibility for the medical care of the participants.
• Oversee the medical service team to promote quality and outcome goals.
• Overall responsibility for the implementation and oversight of the QAPI activities, and QAPI plan. Studies data, reviews procedures, identifies problems and makes necessary corrections to ensure the QAPI plan is viable, and data has integrity.
• Chair of the Quality Assurance Committee.
• Provide medical oversight in the development of standards and uniform treatment policies and procedures to assure they are inclusive of the knowledge and values which guide PACE Partners of NE FL.
• Develop and maintain written objectives, policies and procedures, an organizational plan, and a quality assurance program for the medical service. All medical policies shall be reviewed at least annually.
• Coordinate and integrate medical services with other participant care services to provide a continuum of care for the participants
• Develop, implement, and monitor outcome measurements to assure appropriate and efficient utilization of all health care services including :
• Hospital inpatient and ER utilization
• Pharmaceuticals
• Specialist referrals
• Medication management
• Nursing facility utilization
• When utilization problems are identified, research best practices and work with clinical staff and interdisciplinary team to make appropriate procedural and or operational changes to bring utilization into alignment with established PACE best practices.
• Supervise [PACE Organization] primary care practitioners :
• Recruit and train primary care physicians and geriatric nurse practitioners
• Assist in developing and maintaining written job descriptions for the medical staff. Participate in the review of credentials and delineation of privileges of medical staff members, and assign duties based upon education, training, competencies, and job descriptions.
• Participate in annual performance evaluations of Primary Care Physicians and Nurse Practitioners.
• Consult with primary care staff to discuss clinical and case management issues
• Monitor clinic operations to assure integration of primary care and nursing services
• Oversee and ensure appropriate diagnostic coding practices of Primary Care Physicians.
• Participate in primary care, hospital and nursing home rounds, and the 24-hour on-call system to assure continuity of care for PACE participants.
• Ensure that medical staffing patterns are implemented
• Act as community liaison with physician groups, specialists, and hospitals to represent [PACE Organization] and assure good provider relationships.
• In conjunction with the Executive Director, participate in contract negotiations and monitoring with medical and health related providers.
• Provide leadership with medical staff, promoting the goals and needs of [PACE Organization] and those it serves.
• Participate with the executive management group in internal operations, program development and resource utilization.
• Participate in staff orientation and staff education activities.
• Participate in continuing education and training of all [PACE Organization] staff.
• Participate in the National PACE Association physician network to assure representation and recognition.
• Identify opportunities for clinical and health care delivery research which will enhance the geriatric leadership role of [PACE Organization] in clinical expertise and innovation.
• When acting as Primary Care Physician, maintain daily attendance at and participate in interdisciplinary team meetings, communicating participant changes, collaborating on care planning decisions and coordination of 24-hour care delivery.
• When acting as Primary Care Physician, evaluate and treat participants during acute illness. Oversee and manage participants’ use of medical specialist and inpatient care. Admit participants to the hospital, provide primary care or coordination of care with hospitalists, remain responsible for medical management, and provide updates to interdisciplinary team. In conjunction with the interdisciplinary team, plan, and coordinate discharge.
• Participate in planning and budgeting for the Medical Services
• Comply with all state and / or federal regulations to ensure the needs of each participant is met across all care settings 24-hours a day, every day of the year.
• Comply with all state and / or federal regulations to ensure reasonable and timely access to specialists as indicated by participant’s health conditions and consistent with current clinical practice guidelines.
• Comply with all state and / or federal regulations to ensure provision of services are documented, tracked, and monitored across all care settings.
• Comply with all state and / or federal regulations to ensure oversight of participants’ use of medical specialists and / or inpatient care.
• Comply with all state and / or federal regulations to ensure required assessments are conducted in response to each service determination request.
• Comply with all state and / or federal regulations to ensure the organization is performing assessments, collecting and analyzing the data from these assessments to take actions to improve the quality of the participant’s life.
• Comply with all state and / or federal regulations to ensure the IDT is conducting unscheduled reassessments as required.
• Comply with all state and / or federal regulations to ensure orders are based on the participant’s current needs and / or clinical practice guidelines.
• Comply with all state and / or federal regulations to ensure the IDT coordinates 24-hour care delivery that meets the needs of each participant across all care settings.
• Comply with all state and federal regulations to ensure that all ordered, approved, or care planned services are provided to the participant.
• Comply with all state and / or federal regulations to ensure all complaints regarding quality of care or service delivery are properly processed as a grievance.
• Comply with all state and / or federal regulations to ensure all individual issues within a grievance are reviewed, considered, and resolved.
• Comply with all state and / or federal regulations to ensure immediately approved SDRs have notification of the approval during the same encounter and / or interaction.
• Comply with all state and / or federal regulations to ensure all participant medical records are complete, accurate and accessible to all staff.
• Act only within the scope of practice.

Qualifications and Requirements

Education / Training / Certifications

Experience

Minimum of 2 years' experience working with a frail or elderly population. Minimum of 2 years' experience managing, training, and providing oversight to other advanced care practitioners. Prior PACE and / or value-based care experience preferred.

Job Type : Full-time

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